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Images in vascular medicine
Martin Mory, Jochen Hansmann, Jens-Rainer Allenberg, Dittmar Boeckler
To cite this version:
Martin Mory, Jochen Hansmann, Jens-Rainer Allenberg, Dittmar Boeckler. Images in vascular medicine. Vascular Medicine, SAGE Publications, 2007, 12 (4), pp.381-382.
�10.1177/1358863X07083276�. �hal-00571369�
Vascular Medicine 2007; 12: 381–382
© 2007 SAGE Publications 10.1177/1358863x07083276
Los Angeles, London, New Delhi and Singapore
Images in vascular medicine
Rapid expansion of an inflammatory abdominal aortic aneurysm
Martin Morya, Jochen Hansmannb, Jens-Rainer Allenbergaand Dittmar Boecklera
Departments of aVascular and Endovascular Surgery and
bRadiodiagnostics, University of Heidelberg, Heidelberg, Germany
Address for correspondence: Martin Mory, Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Tel:⫹49 6221 566249; Fax: ⫹49 6221 565423; E-mail: martin.mory@
med.uni-heidelberg.de Panel A
Panel B A 61-year-old patient was hospitalized for unclear
abdominal pain, fever and cough for several days. A chest X-ray showed bilateral pneumonia. Further inves- tigation, including computed tomography (CT), revealed an abdominal aortic aneurysm (AAA) with a maximum diameter of 42 mm and without signs of rupture (Panel A). The patient was treated with antibiotics for 8 days and the AAA was observed. The patient presented to the emergency room 3 weeks later with an acute
abdomen. A repeat CT scan demonstrated an increase in the size of the infrarenal AAA to a maximum diameter of 100 mm with signs of contained rupture (Panel B; Panel C, white arrow) and a large retroperitoneal hematoma.
Immediate open surgery with insertion of a tube graft was performed. The intraoperative findings showed an inflamed, thickened wall of the aneurysm with contained ventrolateral rupture. The patient recovered uneventfully.
Microbiological examination of the aortic wall was nega- tive for organisms.
The growth rate of an AAA is reported to be 2.6 mm on average per year.1This case demonstrates that the rate of AAA expansion is not predictable and varies individ- ually. Inflammation may influence this process and accelerates AAA expansion dramatically.2 This may be correlated with specific cellular immune responses.3,4 In conclusion, ultrasound surveillance of small AAAs is mandatory and requires individualization with more
intensive follow-up for suspected inflammatory aneurysm.
References
1 Brady AR, Thompson SG, Fowkes SG, Greenhalgh RM, Powell JT and the UK Small Aneurysm Trial Participants.
Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 2004; 110: 16–21.
2 Borris LC, Nohr M, Petersen K. Rapid growth and early rup- ture of a primary mycotic aneurysm of the abdominal aorta.
Eur J Vasc Surg 1989; 3: 461–63.
3 Shimizu K, Mitchell RN, Libby P. Inflammation and cellular immune responses in abdominal aortic aneurysms.
Arterioscler Thromb Vasc Biol 2006; 26: 987–94.
4 Hsu RB, Chen RJ, Wang SS, Chu SH. Infected aortic aneurysms: clinical outcome and risk factor analysis. J Vasc Surg 2004; 40: 30–5.
382 M Mory et al
Vascular Medicine 2007; 12: 381–382
‘Images in vascular medicine’ is a regular feature of Vascular Medicine. Readers may submit original, unpublished images related to clinical vascular medicine to: Mark A Creager, Editor in Chief, Vascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
Panel C
